Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Reconstr Microsurg. 2024 Feb;40(2):156-162. doi: 10.1055/a-2102-0040. Epub 2023 May 26.
The profunda artery perforator (PAP) flap has emerged as an excellent secondary option for autologous breast reconstruction. Despite the increased acceptance, potential secondary benefits concerning aesthetic proportions of proximal thigh and buttock at the donor site have never been systematically investigated.
A retrospective review of 151 patients who underwent breast reconstruction with horizontally designed PAP flaps (292 flaps) from 2012 to 2020 was performed. Patient characteristics, complications, and numbers of revision surgeries were collected. In bilateral reconstructions, pre- and postoperative standardized patient photographs were analyzed to identify postoperative changes in proximal thigh and buttock contour. The patients' own perception of postoperative aesthetic changes was determined by an electronic survey.
The patients had a mean age of 51 and a mean body mass index of 26.3 kg/m. The most common complications were minor and major wound complications affecting 35.1% of patients, followed by cellulitis (12.6%), seroma (7.9%), and hematoma (4.0%). A total of 38 patients (25.2%) underwent revision of the donor site. After reconstruction, patients were found to have aesthetically improved proximal thigh and buttock proportions, indicated by a wider thigh gap (thigh gap-hip ratio: 0.05 ± 0.04 vs. 0.13 ± 0.05, < 0.0001) and reduction in lateral thigh-to-buttock ratio (0.85 ± 0.05 vs. 0.76 ± 0.05, < 0.0001). Among the 85 patients who responded to the survey (56.3% response rate), 70.6% felt that PAP surgery had aesthetically either improved their thigh contour (54.12%) or not changed it (16.47%), whereas only 29.4% reported that the surgery negatively impacted their thigh contour.
PAP flap breast reconstruction leads to improved aesthetic proportions of the proximal thigh and buttock. This approach is ideal for patients with ptotic tissue of the inferior buttocks and medial thigh, a poorly defined infragluteal fold, and inadequate anterior-posterior buttock projection.
深动脉穿支（PAP）皮瓣已成为自体乳房重建的绝佳替代方案。尽管接受程度有所提高，但对于供区近端大腿和臀部的美学比例的潜在次要益处从未得到系统研究。
回顾性分析了 2012 年至 2020 年间接受水平设计的 PAP 皮瓣（292 个皮瓣）乳房重建的 151 例患者。收集了患者特征、并发症和修复手术次数。对于双侧重建，分析术前和术后的标准化患者照片，以确定术后近端大腿和臀部轮廓的变化。通过电子调查确定患者对术后美学变化的自身感知。
患者平均年龄为 51 岁，平均体重指数为 26.3kg/m。最常见的并发症是轻微和严重的伤口并发症，影响了 35.1%的患者，其次是蜂窝织炎（12.6%）、丹毒（7.9%）和血肿（4.0%）。共有 38 名患者（25.2%）接受了供区修复。重建后，患者的大腿和臀部比例美学得到改善，表现为大腿间隙变宽（大腿间隙-臀部比：0.05±0.04 比 0.13±0.05， < 0.0001）和外侧大腿与臀部的比例降低（0.85±0.05 比 0.76±0.05， < 0.0001）。在 85 名回应调查的患者中（56.3%的回应率），70.6%的患者认为 PAP 手术在美学上要么改善了他们的大腿轮廓（54.12%），要么没有改变（16.47%），而只有 29.4%的患者报告手术对他们的大腿轮廓产生了负面影响。
PAP 皮瓣乳房重建可改善大腿近端和臀部的美学比例。这种方法适用于臀部和大腿内侧下垂组织、臀下线定义不清、前后向臀部投影不足的患者。
